After its first meeting, NICE's QOF committee said: 'There is a need for clearer criteria for evaluating indicators.'

The scoring system also needed to be more easily understood, and changes will be incorporated into a new decision-making tool, the committee said.

Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre (NPCRDC) which is leading the review of the indicators, said that piloting of indicators was progressing 'very well'.

'We have been absolutely delighted by the positive responses we have had from practices in the 13 PCTs across England that we are currently working with,' she said.

The NPCRDC will be working with 30 practices in the autumn and winter, asking them to keep workload diaries of how much time they spend on activities such as talking to practice staff involved in delivering them in detail and to patients on the receiving end of care.